1. Aerosolized Ribavirin Administration John Dobrozsi R.R.T Clinical Specialist Respiratory Care Services UWMC

2. Aerosolized Ribavirin Administration

6. Aerosolized Ribavirin Administration Initial Treatment RN: Completes Ribavirin Initiation Sheet found in “Ribavirin Packet”

7. Aerosolized Ribavirin Administration Room Preparation  RN and RT:  Remove non-essential items from room  Ask patient to void  Patient removes contact lenses if worn  Patient dons cloth gown. Hair cover is provided if patient has hair

8. Aerosolized Ribavirin Administration Room Preparation

9.  RN and RT:  Drape patient and bed

10. Aerosolized Ribavirin Administration Room Preparation

13.  RN and RT:  Drape patient and bed  Drape horizontal surfaces in room

14. Aerosolized Ribavirin Administration Room Preparation

16.  RN and RT:  Drape patient and bed  Drape horizontal surfaces in room  Review SPAG ON/OFF procedure

17. Aerosolized Ribavirin Administration Room Preparation

19.  RN and RT:  Drape patient and bed  Drape horizontal surfaces in room  Review SPAG ON/OFF procedure  RN:  Call Environmental services of treatment end time

20. Aerosolized Ribavirin Administration Treatment Initiation RN and RT: Complete Treatment Check List Before Each Treatment

21. Aerosolized Ribavirin Administration Treatment Initiation  RT:  Set up DeMistifier tent and tuck in around mattress  Tape front opening together on tent

22. Aerosolized Ribavirin Administration Treatment Initiation

25.  RT:  Set up DeMistifier tent and tuck in around mattress  Tape front opening together on tent  Place aerosol mask on patients face  Turn on Demistifier tent and assure concave appearance of tent  Check for warning lights on Demistifier control panel

26. Aerosolized Ribavirin Administration Treatment Initiation

28.  Turn on SPAG nebulizer  Observe patient for adverse reactions (Wear PAPR if inside room)

29. Aerosolized Ribavirin Administration Treatment Initiation

31. Aerosolized Ribavirin Administration During Therapy  Wear full PPE when entering room.  SPAG may be turned off if patient care requires entering tent.  Leave scavenger tent fan running at all times during treatment.

32. Aerosolized Ribavirin Administration During Therapy  Treatments begin and end at:  22:00 – 00:00  06:00 – 08:00  14:00 – 16:00  New therapy orders will be started at the soonest treatment time following arrival of the drug.

33. Aerosolized Ribavirin Administration Completing Therapy  RT  Following the 2 hour treatment, the RT will turn off the SPAG unit.  The scavenger tent will continue running until the room is undraped.  Drapes on room and patient are folded “inward” upon themselves and placed in linen hamper.

34. Aerosolized Ribavirin Administration Completing Therapy

36.  The scavenger tent is folded in upon itself with the fan running.  The tent remains folded behind the bed until the next treatment.

37. Aerosolized Ribavirin Administration Completing Therapy

38.  RN calls Environmental Services to alert them of the need for room cleaning.  RN and RT sign the back of the Ribavirin treatment check list.  Full PPE must be worn until Environmental Services had cleaned the room.

39. Aerosolized Ribavirin Administration Completing Therapy  The procedure for ventilated patients is the same except that a scavenger tent is not used and patient/room draping is unnecessary.  The ventilator/SPAG circuit is a closed system.

40. Aerosolized Ribavirin Administration Completing Therapy  At the end of each cycle of therapy, the tent and SPAG parts are disposed of.